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A 29-year-old man with a 3-month history of blurred vision and micropsia in the left eye
Digital Journal of Ophthalmology 2008
Volume 14, Number 17
September 5, 2008
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Anupma Kumar | St. Paul's Eye Unit, Liverpool
Edward Doyle | Cheltenham General Hospital
Diff DX
Central serous retinopathy (CSR)
In CSR there is a localized serous detachment of the neurosensory retina in the region of the macula secondary to focal RPE defects. There is no optic disc pit seen as in this case. In CSR, fluorescein angiography can show a ‘smoke-stack’ appearance, which was not seen in this case either. The lack of these findings excludes this as the diagnosis.

Retinal pigment epithelial detachment (PED)
PED is probably caused by reduction of the hydraulic conductivity of the thickened Bruch’s membrane, thus impeding movement of fluid from the RPE towards the choroid. OCT images show separation of the RPE from Bruch’s membrane by the fluid in PED. There is no sub-RPE fluid in this case, and the clinical appearance excludes this as the diagnosis.

Age related macular degeneration (AMD)
AMD usually affects patients over the age of 50 years and is the most common cause of irreversible visual loss in the developed world. Clinical features include the presence of drusen, pigment epithelial alterations, hemorrhages, choroidal neovascularization and RPE detachment. In view of the age of this patient (29 years) and the lack of other AMD clinical features, this is not the diagnosis.
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